| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
761 |
554 |
$460K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
477 |
396 |
$234K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,493 |
855 |
$192K |
| D2950 |
|
1,230 |
953 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,017 |
364 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
848 |
828 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,448 |
1,357 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,378 |
1,331 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
174 |
$44K |
| D1110 |
Prophylaxis - adult |
860 |
839 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,575 |
1,520 |
$36K |
| D0274 |
Bitewings - four radiographic images |
924 |
893 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,581 |
1,452 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
357 |
215 |
$23K |
| D1120 |
Prophylaxis - child |
265 |
255 |
$9K |
| D1206 |
Topical application of fluoride varnish |
175 |
172 |
$3K |
| D0270 |
|
154 |
143 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75 |
48 |
$555.80 |